Provider Demographics
NPI:1699650747
Name:WIGGINS, SA'NEALDRA (RDN)
Entity type:Individual
Prefix:
First Name:SA'NEALDRA
Middle Name:
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 WILMA RUDOLPH BLVD
Mailing Address - Street 2:STE F PMB 273
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040
Mailing Address - Country:US
Mailing Address - Phone:931-217-5534
Mailing Address - Fax:
Practice Address - Street 1:2250 WILMA RUDOLPH BLVD
Practice Address - Street 2:STE F PMB 273
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040
Practice Address - Country:US
Practice Address - Phone:931-217-5534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-07
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5201133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered